Thursday, May 21, 2009

Greed in medicine: a perspective from the borderlands of civilization

Volume 1, number 1 of the short-lived Oregon Medical Journal, a publication of the Marion County Medical Society, contains the Original Communication "The code of ethics -- shall it be enforced?" A response to a piece on the merits of the AMA code by one Y.S. Franklin in the Cincinnati Lancet and Observer, the unsigned comment is interesting reading for these modern times.

The writer, presumably one of the journal's editors (who were C.H. Hall, A. Sharples, and L.L. Rowland, all faculty at the Willamette University Medical Department) takes aim at the greed of some of his fellow physicians:
If a physician's office is like a pawn-broker's shop, a place solely to extort money from the unfortunate and necessitous, then it would be consistent and in keeping with the proper function of the profession for each doctor to do as he pleased, and make money the best he could, without regard to any rule of action, no matter from what source it may emanate. But if physicians are in reality a body of men who, actuated by high motives and noble impulses, making the relief of the suffering of their fellow-men the prime object being foremost in their estimation, then, indeed, is it proper for any member of the profession to speak out and expose any one who, claiming fellowship with it, would, Judas-like, sell his Master for thirty pieces of silver.
Further on, he proposes a course of action:
As a remedy for this evil, which seems to be a growing one, let each Society, State or County, rid itself of all irregular excresences, and then report them to their Alma Mater, to deal with them as abandoned, profligate and unworthy sons, who, like Pilot [sic] and Herod, have combined together to injure, and if possible destroy, the usefulness of the profession, in order that they may reap pecuniary benefit by imposing upon their community.
One wonders whether the mechanism by which the alma mater would "deal with" these greedy graduates would be the reduction of their personal fortune through a sizeable gift to the school. Just a thought...

The matter of medical ethics was a sensitive one in the Oregon of the 1870s, since, as the writer notes, "We have here in Oregon a new State; our State Society is just formed; we are upon the very borders of civilization, and it is a matter of paramount importance that, isolated as to a great extent we are, we should make a new beginning."

Ah, good stuff. But here's some even better stuff: one of our predecessors here at the library took the time to compile a list of the (eclectic) contents of the entire run of the Oregon Medical Journal (four issues, June 1876-March 1877). All hail librarians!

Vol. 1, no. 1:
Editorial: Salutatory ; Practical medicine as a science ; Physiological action of lobelia ; State Medical Society ; Medical witnesses in the courts ; Commencement, Department of Medicine, Willamette University
Original communications: The code of ethics--shall it be enforced? ; History of the Medical Department of Willamette University ; Extirpation of a stricture of the urethra
Book notices
Miscellaneous: Original prescriptions ; Carbolic acid as a local anesthetic ; Simple test for blood ; Method of arresting epistaxix ; Comedones ; Conium in dysmenorrhea

Vol. 1, no. 2:
Original communications: Quacks and doctors ; Report of Committee on Obstetrics to State Medical Society ; Suppression of urine relieved by Faradization
Editorial: Medical legislation ; Patheys and isms
Book notices
Miscellaneous: Castor oil ; Morphia in sea-sickness ; Poisoned meat ; Hydrophobia ; Death from chloroform ; Acute rheumatism treated by salicylic acid ; Salicylic acid as an antiseptic

Vol. 1, no. 3:
Original communications: Peri-nephritic abscess ; Entomology ; Apparatus for holding infants during surgical operations about the face
Editorial: Diphtheria ; Electricity as a therapeutic agent ; How are maternal impressions made on the foetus in utero?
Miscellaneous: Report of a case of poisoning by gelsemium ; A new mode of obtaining local anesthesia ; Wadding vs. sponges ; Treatment of diphtheria by clysters ; Gelseminum ; Prevention of miscarriage ; Preservation of ice ; Abortive treatment of erysipelas ; Surgery, on ainhum ; Antidote for carbolic acid ; Treatment of rheumatic fever ; Ozone observations in Paris ; Violent pain ; Intermittent diarrhea ; Respiratory movements

Vol. 1, no. 4:
Original communications: [On diphtheria] by Phillip Harvey ; [Case report, malnutrition] by W.A. Cuseck
Editorial: Diphtheria and its treatment ; Correct habits a preventive of disease
Miscellaneous: The bandage in thoracic diseases ; Treatment of acute dysentery by injections of hot water ; New test for albumen ; Homoeopathic soup ; Quackery ; Close of volume ; Medical Society of the State of Oregon ; Obituary [John Vite, M.D.]

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